Name: Evaluation Of Intra-Procedural Blood Pressure In Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy
Start: 2026-05-01T09:30:00-0400
End: 2026-05-01T09:50:00-0400

Evaluation Of Intra-Procedural Blood Pressure In Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy

Friday May 1, 2026 9:30am - 9:50am EDT

Athena G

Sarah Layne, Chelsea Mitchell, Sterling Torian, Austin Roberts
TriStar Centennial Medical Center – Nashville, Tennessee

Background: Blood pressure (BP) control is an essential component in management of patients with acute ischemic stroke (AIS). Significant reductions in BP can lead to hypoperfusion and worsened cerebral injury, whereas uncontrolled hypertension can increase the risk of hemorrhage and cerebral edema. In patients undergoing mechanical thrombectomy (MT), current guidelines recommend a pre-procedure BP less than 185/110 mmHg, but intra-procedural goals have yet to be established. Literature evaluating intra-procedural BP goals in patients undergoing mechanical thrombectomy is lacking. Current randomized controlled trials have evaluated the use of anesthesia, which may impact hemodynamics. Further studies are needed to determine if there is an ideal blood pressure target to prevent neurologic deterioration and worse functional outcomes. The purpose of this study was to evaluate the effect of intra-procedural blood pressure on clinical and safety outcomes in acute ischemic stroke patients undergoing mechanical thrombectomy.

Methods: This was a single-center retrospective cohort study conducted through chart review from October 1, 2022, to June 30, 2025. Patients who underwent MT within the study timeframe were included. Exclusion criteria consisted of any intra-procedural hemorrhagic complication, lack of successful reperfusion (TICI score 0-2a), missing baseline Glasgow Coma Scale (GCS), or patients aged less than 18 years old. Patients were divided into two groups, those who had an intra-procedural systolic blood pressure (SBP) less than 140 mmHg or a drop in SBP by at least 40 mmHg (group 1) and those who did not meet the criteria (group 2). The primary outcome was incidence of neurologic deterioration at 24 hours post-mechanical thrombectomy, defined as a decrease in GCS score of at least 2 from the baseline score. The secondary outcome was incidence of intracranial hemorrhage at 48 hours. Subgroup analyses were performed for patients who received intravenous (IV) fibrinolytics and those who did not, and separately for patients with any intra-procedural SBP less than 120 mmHg compared with those who had SBP greater than 120 mmHg.

Results: Fifty-four patients were screened. Five patients did not meet inclusion criteria, and thirteen patients were excluded (n=5 lack of successful reperfusion, n=1 intra-procedural hemorrhagic complication, n=7 missing baseline GCS). This resulted in a final sample size of thirty-six. All patients met criteria for group 1 (n=36). Six patients (16.7%) developed neurologic deterioration at 24 hours. Eighteen patients (50%) had some degree of intracranial hemorrhage, as determined by any mention of hemorrhage on brain imaging. In the subgroup analysis comparing patients who received IV fibrinolytics with those who did not, 1 of 9 patients (11%) in the fibrinolytic group had neurologic deterioration, compared with 5 of 27 patients (18.5%) in the non-fibrinolytic group. Neurologic deterioration occurred in all six (100%) patients in the SBP less than 120 mmHg subgroup.

Conclusions: Our study found that 16.7% of patients had neurologic deterioration 24 hours post-procedure. All patients who received MT had an intra-procedural SBP less than 140 mmHg or a drop by 40 mmHg; therefore, we were unable to detect differences between groups for our original analysis. While not powered for significance, patients who did not receive fibrinolytic therapy as well as those with intra-procedural SBP less than 120 mmHg had numerically higher percentages of neurologic deterioration at 24 hours. Further research is warranted to determine the optimal intra-procedural SBP goal for patients undergoing MT.

This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.

Moderators

Cassandra Wade

Pharmacy Procurement Coordinator, John D Archbold Memorial Hospital

Presenters

Sarah Layne

Sarah is a 2025 graduate of Belmont University School of Pharmacy. She is currently a PGY-1 resident at TriStar Centennial Medical Center in Nashville, TN. Sarah will be completing a PGY-2 Critical Care Residency Program next year with plans of becoming a Critical Care Clinical P... Read More →

Evaluators

Madison Yates

Clinical Pharmacist Practitioner, PGY1 Ambulatory Residency Program Coordinator, Cone Health

Friday May 1, 2026 9:30am - 9:50am EDT
Athena G

Critical Care/Emergency Medicine (CCM), TriStar Centennial Medical Center

global Y

2026 Southeastern Residency Conference

Cassandra Wade

Sarah Layne

Madison Yates

Attendees (10)

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2026 Southeastern Residency Conference

Cassandra Wade

Sarah Layne

Madison Yates

Attendees (10)

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